Using an interpreter in a consultation
The following section is based on the RACGP accepted clinical resource Guide for Clinicians Working with Interpreters in Healthcare Settings produced by the Migrant and Refugee Women’s Health Partnership. Using an interpreter in a consultation constitutes the presence of a third party. Accredited practices should ensure their processes meet Criterion C2.2 (Presence of a third party during a consultation) of the Standards.
When to engage an interpreter
A GP should not assume a patient does not need an interpreter based solely on the patient’s ability to hold a general conversation. Medical conversations often need to convey specific, complex information that must be strictly adhered to and require a sophisticated understanding of language to be properly understood. Patients may be embarrassed by or ashamed of their English proficiency and may not raise their difficulty with English comprehension to their GP voluntarily. While a patient’s family/ friend, or a member of the practice team who speaks the same language, may seem a convenient solution, it is inappropriate as it does not ensure confidentiality, impartiality or accuracy of the translation.
Discussing difficult or sensitive topics such as end of life care, bad medical news and mental, sexual, or reproductive health can be uncomfortable, distressing or traumatic for those not appropriate to translate such conversations, including minors. Involving a translator in a consultation may be crucial to ensuring a patient provides informed consent before agreeing to a method of treatment. If a GP provides treatment to a patient with difficulties in English proficiency without using a translator, it may be difficult to prove informed consent was attained from a medico-legal perspective. Translators also help to ensure the patient has fully understood any instructions that have been given to them and, if followed, positive care outcomes are more likely.
If a GP believes the consultation may benefit from the use of an interpreter, they should offer to bring one into the consultation. If a patient refuses an interpreter the GP should first address the patient’s concerns (confidentiality, impartiality, cost, speaking with someone of the appropriate gender etc). If the patient continues to refuse an interpreter, the GP should explain the interpreter is also for the GP’s benefit, so they are confident everything is being communicated correctly and ensure they are doing their due diligence for the patient. If the patient continues to refuse an interpreter, the GP should note the patient’s refusal in their consultation notes and proceed as best as they are able.
Practising with an interpreter
At the start of the consultation
When engaging an interpreter, it is best practice to briefs them on whom they are speaking to and what will be discussed without the patient present. It is possible the GP will need the interpreter to translate very difficult or sensitive subjects to their patient. The interpreter should ideally be aware of this before they begin translating so they can behave appropriately and for their own well-being. There may be some subjects that have significant cultural implications or are inappropriate to discuss with a particular gender that an interpreter may be able to advise the GP about before they proceed. Such a process can be difficult to implement in clinics in fee-for-service settings and when using call centre-based interpreters. Where possible, it is recommended practices develop processes that work for their circumstances to assess the need for an interpreter, gain consent and contact the interpreter before the patient is seen by their GP.
During the consultation
After the interpreter is introduced, the consultation can continue largely as normal. The GP should continue to address the patient, make eye contact if culturally appropriate and use first person pronouns (eg continuing to say “Can you tell me if your chest hurts?” rather than “Ask him if his chest hurts”). For interpreters to fulfil their role they need to translate exactly what is said to ensure the patient is fully able to participate in the consultation. When working with an interpreter GPs should speak at a reasonable speed, use appropriate pauses and avoid overlapping speech to make the interpretation more manageable. While interpreters often have strategies to manage long speech segments such as cutting in to interpret while others are speaking, interpreting simultaneously and asking for repetitions, these can be disruptive to the consultation. GPs should be mindful of the volume of information they are conveying and provide appropriate pauses to provide an opportunity for interpretation. If the interpreter begins using strategies to manage long speech segments or asks the GP to pause so they can translate, GPs may need to use smaller speech segments if possible for the consultation.
When speaking, the GP should use simple language and avoid colloquialisms, acronyms and technical language where possible. Where technical language or complex language is necessary, GPs should explain the terms and concepts in plain English as much as possible so the interpreter can convey those explanations to the patient. It is recommended that GPs confirm patients have understood what they have said by asking the patient to explain the GP’s advice back to them or to outline what the next steps for treatment are back to the GP.
After the consultation
It may be beneficial to debrief with the interpreter to manage emotions, share insights into the translation and have both parties provide feedback. After a difficult consultation, it is valuable for parties to discuss what occurred and make sure they are emotionally safe. The interpreter can also provide feedback on the patient’s linguistic and speech characteristics to give the GP additional insights into the consultation. Professional feedback can also be provided at this time to help the GP work better with an interpreter and to help the interpreter better manage their role as well.